It is important for diabetic patients to realize the importance of maintaining natural teeth. Natural teeth are unrivaled by dentures in allowing for pleasant and comfortable chewing. Denture efficiency is usually limited by the consistency of food that the denture-wearer eats. Consider vegetable, the mainstay of the diabetes diet, as an example.
Vegetables require some degree of chewing before it can be swallowed. Patients who wear complete dentures commonly complain of the difficulty in chewing vegetables. Some denture wearers intentionally avoid this food while others resort to prolonging cooking time in order to soften food to tolerable chewing consistency. However, prolonged cooking diminishes the nutritional value of the food and renders it unpalatable in appearance and texture.
It is therefore, in the best interest of diabetics to maintain their natural teeth in order to comply with their doctor's recommended diet.
Furthermore, some studies have shown that diabetics need to frequently have their dentures relined because they experience a faster rate of bone resorption.
Saliva, which acts as a lubricant between the denture and the oral mucosa, may be deficient in some diabetics. The deficiency in saliva causes friction which injures the mucosa, making it painful to wear dentures.
Preserving your teeth in your mouth means keeping them in a healthy state. It is unwise to allow badly broken down teeth to remain in the mouth. Although these teeth may not frequently cause severe pain anymore, they act as an open portal for infection to set in any time.
Infection in the mouth not only raises blood sugar but also limits food intake. This condition promotes ketoacidosis (a condition wherein acid accumulates in the body) and spread of infection to vital organs in the head and neck area. Infection in the mouth can sometimes lead to serious consequences in the diabetic.
Brushing after every meal and flossing at least once a day are important in order to remove plaque deposits around the teeth. Plaque has the potential to produce caries or tooth decay as well as gum disease. Denture wearers are advised to remove their dentures from their mouth and clean it separately from the teeth. Fixed dentures or bridges (non-removable dentures) should be cleaned with the use of a floss threader. Teeth with loose contacts with the adjacent teeth may be cleaned with the proxabrush.
fig. 1 Toothbrushing Technique - Position the brush 45 degrees to the tooth at the point where the gums meet the tooth. Brush the tooth away from the gums towards the biting surface of the tooth.
fig. 2 Flossing - Pass the floss between the area where the two teeth contact. Insert the floss between the gum and tooth without causing pain or discomfort. Scrape the side of the tooth in a direction away from the gums.
fig. 3 Floss Threader - Insert the floss in the eye of the floss threader. Insert the floss threader under the contact area. Once the floss is through on the other side, floss the sides of the teeth.
fig. 4 Proxabrush - With an in and out motion, insert the proxabrush
between the teeth to clean the sides of the teeth.
Because it is believed that diabetics are more prone to periodontal disease (gum disease), it is desirable that a periodontal screening exam be done every six months.
Periodontal disease or gum disease is not familiar to most. Its presenting signs and symptoms do not carry with it the urgency associated with a painful tooth. In fact, for the most part, it does not cause pain. The need to see the dentist does not become obvious until until the more advanced and serious symptoms appear.
The relationship between periodontal disease and diabetes has been studied for a long time. Although these studies are not in agreement, it is generally accepted that diabetics are more prone to develop periodontal disease. In a study involving Pima Indians in Arizona, it was estimated that diabetics are three times at risk to develop periodontal disease compared to non-diabetics.
fig. 5 Gingivitis.
Periodontal disease may be divided into gingivitis and periodontitis. In gingivitis, the gingiva (gums immediately contacting the tooth) is red, swollen, and may bleed when brushed or flossed. It may be tender but is usually not painful. The bone underneath the gums is unaffected. Pocket probing (a procedure wherein a periodontal probe is inserted between the tooth and the gingiva to measure the depth of the pocket) will reveal pockets not greater than 4 mm.
fig. 6 Peridontitis.
In periodontitis, bone is affected or reduced in height. Pocket probing will reveal pocket depths greater than 4mm. The gingiva may also be red swollen, and may bleed during brushing or flossing. When periodontitis has been present for a long time, the tooth may be seen to move in its socket and the gingiva may be receded (a condition where the gingiva has shrunk and exposed the root of the tooth).
Gingival recession predisposes a tooth to root caries (decay of the root surfaces) and dentin sensitivity (a condition wherein the patient experiences severe pain whenever he brushes his teeth, eats something sweet or drinks something cold).
For gingivitis, scaling and polishing is usually adequate. For periodontitis, root planing or periodontal surgery is required.
fig. 7 Scaling and polishing - the removal of plaque and tartar on the crown of the tooth.
fig. 8 Root Planing - the removal of plaque and tartar on the root surfaces of the teeth.
fig. 9 Periodontal surgery - the gum is lifted from the bone to allow better access in removing tartar and plaque in deeper areas of the root.
Treatment of periodontal disease may be difficult as it requires the patient's cooperation. Both doctor and patient have a role to play in order for the treatment to be succesful. The dentist is responsible for removing all plaque and tartar (hardened plaque) on the teeth while the patient is in the clinic. The patient is responsible for keeping the teeth clean outside the clinic. For most patients, this entails learning new skills, acquiring new habits or even modifying one's lifestyle.
